精神分裂症应用氯氮平228例初期血药浓度与临检指标水平的相关性

目的 研究精神分裂症病人使用氯氮平初期血药浓度与临检指标水平的相关性.方法 收集2018年1月至2019年1月在安徽医科大学附属心理医院住院治疗的精神分裂症病人228例氯氮平血药浓度及其人口学资料和实验室临检指标.采用Pearson相关检验和多元线性回归分析氯氮平血药浓度与实验室临检指标的关系.结果 Pearson相关...     

Telephone-adapted Mindfulness-based Stress Reduction (tMBSR) for patients awaiting kidney transplantation

BackgroundPatients with progressive kidney disease experience increasing physiologic and psychosocial stressors and declining health-related quality of life (HRQOL).MethodsWe conducted a randomized, active-controlled, open-label trial to test whether a Mindfulness-based Stress Reduction (MBSR) program delivered in a novel workshop-teleconference format would reduce symptoms and improve HRQOL in patients awaiting kidney transplantation. Sixty-three transplant candidates were randomized to one of two arms: i) telephone-adapted MBSR (tMBSR, an 8-week program of meditation and yoga); or ii) a telephone-based support group (tSupport). Participants completed self-report questionnaires at baseline, post-intervention, and after 6-months. Anxiety, measured by the State-Trait Anxiety Inventory (STAI) post-intervention served as the primary outcome. Secondary outcomes included: depression, sleep quality, pain, fatigue, and HRQOL assessed by SF-12 Physical and Mental Component Summaries (PCS, MCS).Results55 patients (age 54 ± 12 yrs) attended their assigned program (tMBSR, n = 27; tSupport, n = 28). 49% of patients had elevated anxiety at baseline. Changes in anxiety were small and did not differ by treatment group post-intervention or at follow-up. However, tMBSR significantly improved mental HRQOL at follow-up: + 6.2 points on the MCS - twice the minimum clinically important difference (95% CI: 1.66 to 10.8, P = 0.01). A large percentage of tMBSR participants (≥ 90%) practiced mindfulness and reported it helpful for stress management.ConclusionsNeither mindfulness training nor a support group resulted in clinically meaningful reductions in anxiety. In contrast, finding that tMBSR was more effective than tSupport for bolstering mental HRQOL during the wait for a kidney transplant is encouraging and warrants further investigation.ClinicalTrials.gov NCT01254214.     

Electroconvulsive therapy modulates critical brain dynamics in major depressive disorder patients

BackgroundElectroconvulsive therapy (ECT) is widely considered as an effective and fast-acting option for treating patients with major depressive disorder (MDD). However, the neural basis underlying this powerful therapy remains uncertain. Recent studies have suggested that the healthy brain may operate near a critical state, which may reflect a balance between neuronal excitation and inhibition.ObjectiveIn the present study, we investigated whether there are any changes regarding criticality in MDD and, if so, whether ECT can reverse them. Critical dynamics analyses were performed on resting-state functional magnetic resonance imaging (rs-fMRI) data collected from 39 MDD patients and 38 healthy controls (HCs).ResultsWe found that compared with HCs, MDD patients, especially those who responded positively to ECT, tended to have smaller average avalanch sizes and lower branching ratios, suggesting a sub-critical state, at both the whole-brain and functional network levels. Importantly, ECT effectively corrected such anomalies, accompanied by enhanced degree centrality and functional connectivity of high-degree nodes located in the networks including the default-mode and the frontoparietal networks.ConclusionThese results indicate that ECT can modulate large-scale brain dynamics of MDD patients to be closer to criticality. Our study sheds new light on the pathology of MDD and the network mechanism by which ECT influences treatment.     

Thyroidal stimulation of tubulin and actin in rat brain cytoskeleton

In cultures of neonatal rat brain cells, labeled with ³⁵S-methionine in the presence or absence of triiodothyronine (T₃), the hormone promoted a significant enhancement of labeled tubulin and actin in the insoluble fraction (30,000 g pellet) of cell homogenate. To identify the specific sub-cellular fraction associated with this induction, organ cultures of 1 day rat cerebra were labelled with ³⁵S-methionine in the presence and absence of T₃ and the insoluble fraction (30,000 g pellet) was subfractionated into mitochondria, plasma membrane and cytoskeleton. Analysis of the labeled proteins by SDS-PAGE, autoradiography and densitometry revealed a T₃-induced increase of 50–80% for both tubulin and actin, only in the cytoskeleton fraction without any significant effect on the other fractions. Similar results were obtained when plasma membrane or cytoskeleton were isolated directly from labeled cerebrum by conventional methods instead of fractionating from the 30,000 g pellet. Analysis of relative stimulation of labeled tubulin and actin by T₃ in cytoskeleton fraction derived from primary cultures of neuronal (N) and glial (G) cells labeled with ³⁵-methionine show that the stimulatory effect is predominantly on the N cells. Studies on the kinetics of induction of labeled tubulin and actin by T₃ in the cytoskeleton fraction prepared from cerebra labeled with ³⁵S-methionine for 2, 8 and 18 hrs revealed no significant difference at 2 hrs; at 8 hrs, an increased incorporation into both tubulin and actin was reproducibly seen in the controls relative to T₃-treated samples. However by 18 hrs, this pattern reversed and an enhanced accumulation of both labeled tubulin and actin was observed under the influence of T₃. The mechanism of this apparently intriguing effect of T₃ on the kinetics of association of tubulin and actin with the cytoskeleton has been discussed in the light of the dual effect of the hormone on tubulin viz. enhancing its stability as well as rate of synthesis. The overall results indicate that the thyroid hormones play a major role in the cytoskeletal transport of tubulin and actin from their site of synthesis to that of assembly thus facilitating axodendritic outgrowth and morphological differentiation.     

Vasoconstrictor-mediated release of purines and pyrimidines from perfused rat hindlimb,perfused mesenteric arcade and incubated de-endothelialized aorta

• 1.1. Reperfusion of hindlimbs that had previously been exposed to either 10 or 60 min global ischaemia resulted in transient washouts of uracil and uric acid in approximate proportion to the interval of ischaemia. However, changing the interval of sequential angiotensin II infusions from 10 to 60 min did not affect the magnitude of sustained uracil and uric acid release.
• 2.2. Perfused rat mesenteric artery arcade released uracil and uric acid and each was further increased approximately 2-fold by exposure to the vasoconstrictor, serotonin (6.7 μM).
• 3.3. Incubated de-endothelialized rat aorta also released purines and pyrimidines and this was increased further when subjected to increased work loads.
• 4.4. The increased rates of release of purines and pyrimidines from hindlimb, and the simpler vascular preparations of mesenteric arcade and aorta, were in proportion to the relative rates of increase in oxygen consumption under maximum vascular load.
• 5.5. It is concluded that the release of purine and pyrimidine nucleosides and their catabolites from perfused rat hindlimb occurring as a consequence of vasoconstriction is not the result of release from previously ischaemic tissue. In addition, release of purines and pyrimidines appears to be a general feature of vascular smooth muscle subjected to high workloads.

     

针对高中生自杀倾向的危机干预:1例动力性人际治疗案例报告

一、心理危机与危机干预的概念心理危机是Capland于1964年提出的概念,即当个体面临困境时,先前的处理危机的方式和惯常的支持系统不足以应对眼前的处境时,会出现暂时的心理失衡状态,即心理危机[1].危机干预是给处于危机中的个体提供有效帮助和心理支持的技术[1].当代危机干预往往采用Gilliland和James提出的六个步骤:明确问题、确保安全、提供支持、提出并验证变通的应对方法、制定计划、获得承诺[1].     

Hemodynamic Alterations in the Coronary Circulation of Cardiomyopathic Hamsters: Age and Ang II–dependent Mechanisms

BackgroundCoronary vasospasms have been reported in the early stages of cardiomyopathy in the Syrian cardiomyopathic hamster (CM; BIO-TO2 strain). It has been proposed these alterations could lead to ischemic heart disease and heart failure. However, the cause of these coronary abnormalities has not been established. In this study, we evaluated coronary hemodynamic to assess the role of Ang-II, reactive oxygen species, and nitric oxide (NO) in the development of these alterations in CM of 1, 2, and 6 months of age.Methods and ResultsExcised hearts from control (CT) and CM were retroperfused with Krebs-Ringer bicarbonate solution (KRB), and coronary resistance (CR) was determined. The experimental protocol involved sequential infusions of the thromboxane analog U46619 (THX, 0.1 μmol/L), bradykinin (BKN, 10 μmol/L), and sodium nitroprusside (SNP, 10 μmol/L). Similar experiments were conducted after treatment of hearts with N^ω-nitro-L-arginine methyl ester (L-NAME, 10 μmol/L). Basal CR increased with age, but no significant differences were observed between CT and CM. Reactivity to THX was increased (69%, P < .05) in 2-month-old CM when compared with CT. This effect was observed concomitantly with a significant reduction (53%, P < .05) in BKN-induced relaxation. The reduction in BKN-dependent relaxation was prevented by treatment for 1 month with the antioxidant N-acetylcysteine (1 g·kg·day), or losartan, an Ang II type 1 receptor blocker (10 mg·kg·day). Losartan also prevented the THX-induced increased reactivity in 2-month-old CM. The BKN-induced relaxation occurred through an L-NAME–sensitive pathway that was impaired with age. SNP dilation was preserved in all animal groups.ConclusionsOur results strongly implicate vascular renin-angiotensin-system (RAS) and oxidative stress in endothelial dysfunction and increased reactivity in the early stages of cardiomyopathy in CM. These findings could be relevant to understand the etiology of cardiovascular disorders, in particular, in patients with sarcoglycanopathies.     

The effect of pramipexole on mood and motivational symptoms in parkinson's disease: A meta-analysis of placebo-controlled studies

Background: Mood and motivational symptoms have been reported in up to 35% and 51%, respectively, of patients with Parkinson's disease (PD). Preliminary evidence indicates that pramipexole may have a positive effect on these symptoms.Objective: This analysis was conducted to evaluate the effects of pramipexole on mood and motivational symptoms in patients with PD.Methods: Data for the meta-analysis were extracted from all randomized, double-blind, placebo-controlled trials of pramipexole in the manufacturer's database that included part I of the Unified Parkinson's Disease Rating Scale (UPDRS) as an outcome measure. Only patients with baseline scores >0 (range, 0–4) on item 3 (mood) and item 4 (motivation) were included. Separate analyses were performed for mood and motivational symptoms. The outcome of interest was improvement in scores, with no improvement including both unchanged and increased scores. Odds ratios (ORs), 95% CIs, and Cochran-Mantel-Haenszel tests were calculated to compare rates of improvement and no improvement, stratified by trial.Results: Fourteen randomized, double-blind, placebo-controlled trials of pramipexole were identified, all employing the severity of motor symptoms of PD as a primary outcome. Seven of these trials (N = 1296) employed part I of the UPDRS as a secondary outcome measure and were included in the meta-analysis; no other measure of mood or motivational symptoms was used in any of the 14 studies. Six of the 7 studies included patients with motor fluctuations due to levodo-pa treatment, and the remaining study included patients who did not yet require levodopa. Six studies were published in peer-reviewed journals, and all 7 were included in the New Drug Application for pramipexole. The published study reports were usually limited to motor symptoms; only 1 reported on mood and motivation. However, for the purpose of this meta-analysis, the authors had access to data that were not reported in the original publications. In the pooled data set, 480 patients (59.8% male; mean age, 63.3 years) had a baseline score >0 on item 3 (mood). These mood symptoms improved in 64.7% of patients treated with pramipexole and 43.4% of those receiving placebo (OR weighted by trial = 2.41; P < 0.001). Five hundred seventy patients (64.9% male; mean age, 64.1 years) had a baseline score >0 on item 4 (motivation). These motivational symptoms improved in 63.2% of patients treated with pramipexole and 45.0% of those receiving placebo (OR weighted by trial = 2.06; P < 0.001).Conclusions: This meta-analysis of 7 randomized controlled trials suggests that pramipexole had a beneficial effect on mood and motivational symptoms in PD patients who did not have major depressive disorder. The clinical value of pramipexole in the treatment of depressive and apathetic syndromes requires further investigation.     

预防老年抑郁症复发的最佳证据总结

背景老年抑郁症复发率高,但目前国内外较缺乏预防老年抑郁症复发干预方案的研究。课题组前期探究了老年抑郁症复发的危险因素,其中可控性危险因素为服药依从性差、活动少、进食少。目的 根据以上3个危险因素检索、评价和总结预防老年抑郁症复发的相关证据。方法 2022年10月,计算机检索Web of Science、PubMed、Cochrane Library、美国指南网、英国指南库、加拿大安大略护理学会网站（RNAO）、复旦大学循证护理中心、中国知网等数据库,收集关于预防老年抑郁症和老年疾病伴发抑郁症复发方面的相关证据,包括指南、系统评价、专家共识、证据总结等,检索时限为从建库至2022年10月。由接受过循证医学系统培训的研究者分别采用临床指南研究与评估系统Ⅱ（AGREEⅡ）、AMSTAR、澳大利亚乔安娜布里格斯研究所（JBI）循证中心评价标准（2016版）对纳入的指南、系统评价、专家共识和原始研究进行质量评价。最后采用2014年澳大利亚版本JBI循证卫生保健中心证据分级及证据推荐级别系统进行证据汇总、评价和等级划分。结果 共纳入15篇文献,包括指南3篇、系统评价11篇、随机对照试验1篇。纳入的...